Provider Demographics
NPI:1144407602
Name:COLOMBO DENTAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:COLOMBO DENTAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-799-1787
Mailing Address - Street 1:996 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1251
Mailing Address - Country:US
Mailing Address - Phone:516-799-1787
Mailing Address - Fax:516-799-2623
Practice Address - Street 1:996 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1251
Practice Address - Country:US
Practice Address - Phone:516-799-1787
Practice Address - Fax:516-799-2623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021404-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty